Objective: Improving patient safety in American hospitals is of highest national priority. AHRQ recommends state and local tracking systems to record medical errors. Fears about litigation on the part of hospitals and doctors are in conflict with this goal. Yet, both doctors and hospital systems must cooperate with voluntary error measurement systems in order to improve care. This proposal addresses these tensions. We propose a laboratory study to identify how people assign blame or trust to hospitals and treating physicians under different conditions of medical error disclosure. We will study how these perceptions are affected by communication strategy (letter or face-to-face), sources of communication (hospital team or doctor) and severity of patient outcome resulting from the error (low, medium or high severity). First, we will design communication as part of stimulus development (video and letter.) Second, we will pilot test the stimulus materials for authenticity by asking actual hospital quality directors, doctors and executives to review the materials. Third, we will conduct an experiment by randomly assigning participants to one of twelve groups created by the three manipulated treatment dimensions. Each step will result in practical, empirically-based information about key procedural steps that should be taken for medical error disclosure to patients. Participants: Two-hundred-sixty-four volunteers from the Portland community will be recruited for the experimental study. Portland State University psychology students will assist in stimulus development at design and pilot phases. At least five quality managers, executives and doctors from Providence Health System will review the stimulus materials for authenticity and provide reaction during the pilot phase. Methods: This study will utilize both quantitative and qualitative methodologies to define the best method for communication with patients at disclosure. Participants will be randomly assigned to one of twelve groups that vary communication type, source and medical outcome. Quantitative analyses will determine the degree to which participants assign blame to either hospital and doctor and how much they would trust these entities in the future. Ratings will also be collected about likelihood of litigation and how much the participants endorse a view of their care as a system or as a set of services provided by their doctor. We will determine how these attitudes impact perceptions of the experimental stimuli. Future Studies: The long-term goal of this study is to investigate actual disclosure cases in hospitals. Ultimately, the objective is to educate hospitals and doctors about the optimal manner to disclose medical errors to patients in a way that is most informative and supportive to the patient. In this way the factors that create adversarial relationships in disclosure could be identified and avoided. Evidence-based communication guidelines for medical error disclosure could result from this study. [unreadable] [unreadable]